Soon after I published Food As Medicine in 2011, I received an email from a reader, who wrote about her experience with migraines and magnesium. A long-time lacto-ovo vegetarian, she told me that she took supplemental magnesium each month to control her premenstrual migraines, and that it was the only thing that worked for her.

To be sure, it’s been known for years that magnesium can be helpful in the prevention of premenstrual migraines. Several studies have shown that low serum magnesium is an independent risk factor for migraine headaches, and that magnesium can be used therapeutically to both prevent and treat migraines, as well as a host of other disorders characterized by spasm.

She couldn’t understand why she might be magnesium-deficient, however, because she ate a lot of brown rice, and had been told that brown rice was high in magnesium. According to nutritiondata.com, rice indeed tops the list of all magnesium-containing foods, at 781 mg per 100 mg. Although this refers specifically to just the bran and not the whole grain cereal itself, brown rice still weighs in at a respectable 143 mg of magnesium per 100 g serving. Thus if she ate about three cups of cooked brown rice (about 550 g) on a daily basis, she should have been getting more than 780 mg of magnesium, which is a significant dose by any standard.

It was only after this woman read the sections in Food As Medicine that discuss the importance of fermenting cereals to enhance nutrient absorption, that she put two and two together. Following the instructions in the book (see below), she began to ferment her brown rice before cooking, and a few weeks later noticed that she didn’t experience the same intensity of premenstrual migraines. Inspired by her results, she continued to practice this technique for the next two months, reporting to me in her email that her migraine issues were apparently resolved. Any of my students enrolled in my Food As Medicine program won’t find this to be much of a surprise. One of the central tenets of my nutritional approach is that our issue with diet and its disease-causing potential is a direct result of industrial technologies supplanting traditional methods of food preparation.

All seeds (or more properly ‘fruits’), whether they be cereals, legumes, nuts, or what conventionally call “seeds”, contain a host of natural plant chemicals that serve to discourage predation by animals. This is done to ensure reproductive success, and while this strategy isn’t necessarily effective against all predators, such as insects and birds, it has been very successful against mammalian predators. The extensive grasslands found all over the world are a testament to just how effectively grass seed resists mammalian digestion, and how the grass actually uses these predators to spread it further afield. Such is the strategy of many plants, that sacrifice a part of themselves to ensure the distribution of their genetic material, hopefully dispersed intact, contained within a nutrient-dense clump of “fertilizer”.

Among mammals, however, humans are unique for our relatively recent practice of consuming cereal and legume crops as staples. While a variety of seeds have long been a part of the human diet, the proportion consumed for pre-agrarian peoples was much lower when compared to the farming folk that began to emerge during the 9-10th millennia BCE. The archeological record shows that in every measurable way human health declined with this transition, with clear evidence of physical degeneration, including a loss of height and bone density, and a dramatic increase in dental and skeletal problems.

While this issue of diet and physical degeneration remains perennial throughout the history of human agriculture, the problem stabilizes and begins to reverse as early farming societies discovered the importance of using food preparation techniques such as fermentation, to increase digestibility and nutrient absorption. Since this time, traditional agricultural societies have maintained an unbroken practice of using such techniques to process cereals and legumes, and optimize health. Besides the traditional sourdough breads of Europe, examples of this can be seen all over the world, in traditional foods such as chocolate (from cacao, Central America), ogi (from sorghum, West Africa), injera (from teff, East Africa; pictured below), idli (from rice and urad, South India), and natto (from soy, Japan).

As I articulated earlier, the global exportation of industrial food technologies has meant that much of this knowledge is rapidly disappearing or has been lost entirely. In all of the regions I mention above, industry has either begun to or has entirely supplanted these traditions, as it has in Westernized, ‘First-world’ nations. As a result, we can see how Westernized patterns of disease have crept into these societies, to promote an increasing prevalence of digestive, cardiometabolic, and autoimmune disease. Billions and billions of research dollars are spent each year trying to find a cure for these diseases, when in many cases the cause is entirely related to a loss of traditional knowledge and practices. In 2011, I made the point in Food As Medicine that when wheat is properly fermented, it no longer elicits an immunological reaction in patients diagnosed with celiac disease. This demonstrates that the cause of celiac disease is directly related to a failure to maintain traditional food practices. In my opinion, this finding is just the tip of the iceberg in a huge range of digestive and inflammatory disorders that could otherwise be prevented.

Of course this epiphany for the most part continues to elude modern science, which due to monied interests and its myopic pursuit speculative, novel solutions, has little time for moldy old traditions like food fermentation. But in my clinical experience, and as demonstrated by this woman’s experience with brown rice, we continue to ignore traditional wisdom at the peril of chronic disease.

In Food As Medicine, I discuss two basic methods to ferment cereals and legumes. One way to prepare them is to half-cook them first, and then ferment them in a brine, using some leftover live-culture pickle juice as an inoculant. The last part of the following video (start at 4:47) describes the technique for fermenting cooked chickpeas:

While this makes for a very satisfying result, especially for making bean dishes like hummus, it does take several weeks before its ready. Another technique I mention is a pre-cooking fermentation method, that once you’ve got an inoculum going, only takes 24 hours to prepare. Here it is, taken from the book, Food As Medicine:

Fermentation is a key step in ensuring the digestibility of foods such as cereals, legumes, nuts and seeds all of which contain antinutrient factors (ANFs) such as phytic acid and trypsin inhibitors that impair digestion and inhibit the absorption of nutrients. The procedure to ferment these foods begins with making a starter. Soak the nut, seed, grain or legume in water for 24 hours at 86˚F/30˚C, in a ceramic or glass container. If you don’t live in a tropical climate you will need to use something to keep the ferment warm enough, such as an electric heat mat used for sprouting and germinating seeds. After 24 hours, drain off the liquid, but set aside one cup of the soaking water for later use. Rinse the nut, seed, grain or legume, and prepare as normal.

The cup of soaking liquid that you reserved is full of bacteria, and becomes an inoculum (bacterial culture) for the next batch. Repeat the same process with fresh ingredients, but add the inoculum to the soaking water, and let sit at 86˚F/30˚C for 24 hours. After, drain the soaking water and cook as normal, but retain a cup of the soaking water for the next batch. If you keep doing this, by the fourth time you will have an inoculum that is capable of reducing ANFs such as phytic acid by 96%.[1] While fermentation reduces ANFs, however, it does not remove components such as lectins,[1] and thus the nut, seed, grain or legume usually requires additional measures such as cooking.

Once you have created a viable inoculum, you can store it in a covered vessel the refrigerator for up to a week before it will die, but add a handful of brown rice to give it some food.

“I happened to read about your new book Food as Medicine. In this regard I have some information to share with you. While I was in hospital it was observed that I had mild diabetes, with normal fasting blood sugar and slightly high post-prandial glucose. For 4 months I was taking one tablet of Glimulin® (glimepiride) a day. Thereafter, I stopped it and started taking one teaspoonful of fenugreek powder suspended in one glass of water twice day. My blood glucose is now totally under control. From a search in the internet I found that several papers have reported the anti-diabetic effect of fenugreek. It is harmless and very inexpensive. I trust this letter finds you and family in the best of health.”

Fenugreek is a herb I have been using to control blood sugar in metabolic syndrome and diabetes for a number of years now, often in combination with other herbs for diabetes, including Gurmar (Gymnema sylvestre), Turmeric (Curcuma longa), Ginseng (Panax spp.), Devil’s Club (Oplopanax horridus), Guduchi (Tinospora cordifolia), and Triphala. Taken on its own, however, fenugreek still has a lot of benefit, and is both cheap and easily-available. In my book, Food As Medicine, I have a brief monograph on fenugreek:

“Fenugreek seed, herb (methi): bitter and sweet, warm in quality. Reduces vata and kapha. Used to stimulate the appetite and raise the natural fire of the body, making it useful for digestive problems including constipation, colic, parasites and hemorrhoids. Also used to dispel fatigue, strengthen the heart, and balance blood sugar. One small handful of the fresh leaf can be added as a garnish near the end of cooking. Use ½ – 1 tsp of the seed in stews.”

I frequently add fenugreek to my food, but this reader points out, it can also be used as a medicine. As a digestive aid fenugreek is useful not just because it can boost the digestive fire, but because it has a mucilaginous property it can help to lubricate the intestines and bowel. It may seem surprising that fenugreek has mucilage considering just how hard the seeds are, so to get the best effect make sure to grind the seed into a powder and infuse it in hot water. While fenugreek also adds nutrients and flavor to meals, preparing it as a hot infusion is better than mixing it with food to control blood sugar. The active ingredient in fenugreek that helps to control blood sugar is a soluble fiber called galactomannan, but more recent research suggest other molecular mechanisms for its hypoglycemic property, which are almost as potent as insulin. Fenugreek also exhibits antiinflammatory properties, supporting its traditional indication as a blood cleanser, making it useful for diseases such as arthritis and skin problems. For medicinal purposes, 1-2 teaspoons of fenugreek can be ground into a powder, and infused in a half a cup of hot water. When cool, drink the liquid and the powdered fenugreek together.

In Hindi the name for fenugreek is methi, referring to the use of both the seeds as well as the leaves. The seeds provide for a characteristically bitter-sweet taste that is reminiscent of maple syrup. This smell is due to the presence of an aromatic lactone called sotoloneone, which is extracted from fenugreek seed and used as a flavoring for artificial maple syrup. In fact, if you eat a lot of fenugreek, you may even begin to detect a maple syrup body odor, as your body excretes the solotone in your sweat. The leaves can also have this effect, but to a lesser degree. I have never noticed an issue myself, although apparently some people are more sensitive. I particularly love fresh methi leaves, which can be added to soups and stews just like you would cilantro. In Food As Medicine, I provide a recipe for methi tepla, which is a sourdough flatbread (roti) made with fresh methi leaves:

Directions
Grind the flour to the desired consistency using a coffee grinder or a grain mill. Mix the flour and sourdough culture together, adding in a little water as required, and knead well. Place in a bowl and drizzle a little olive oil over the surface of the dough to keep it moist. Cover with a wet cloth, let sit for several hours in a warm place, and let it ferment (2-18 hours – longer is better). After fermentation, knead the dough again, mix in fresh methi, sesame seeds, ajwain, turmeric, black pepper and salt. When mixed, break off pieces of the dough about the size of a golf ball, roll into a ball and put aside. Warm a large cast iron pan to medium heat with no oil. Sprinkle some flour onto a large flat surface such as a cutting board or a counter, and roll out each ball until it is a round, thin disc, and immediately place in the pan. Cook for approximately 1-2 minutes on each side. When golden brown, take the roti out of the pan and then place them on a hot burner very briefly until they puff up. Serves 3-4 people.

A couple of years ago, I was chatting with my friend, colleague, and co-herbalist Thomas Avery Garran about the use of fenugreek in Chinese medicine. Some Chinese sources state that fenugreek is used to boost yang energy in the body, and I was curious to see if it was used in actual practice. According to Thomas, it is used for this purpose, but it is often neglected. For an inexpensive and common herb, fenugreek perhaps seems a little out of place with expensive and exotic yang tonics such as ginseng, eucommia and deer antler. When viewed from the perspective of Ayurveda, however, in which fenugreek is used to boost metabolism, as well as reduce dryness (vata) and cold (kapha), it definitely supports its use as a yang tonic in Chinese medicine.

Lastly, I would be remiss if I didn’t mention just how useful fenugreek is as a milk-promoter (galactagogue) for new moms, possibly helping by boosting prolactin levels. In India, fenugreek often comprises a number of different home remedies for this purpose, usually combined with herbs such as fennel and ajwain. There is also some suggestion that fenugreek may enhance breast size. Like many other members in the legume family, such as red clover and soy beans, fenugreek contains phytoestrogens that mimic the effects of estrogen. As breast growth is in part dependent upon estrogen, this weak estrogenic effect combined with its galactagogue properties, fenugreek may indeed act to enhance breast size. But I wouldn’t recommend taking in large amounts for this purpose, as the hormonal effects will likely resemble premenstrual symptoms, characterized by swollen, sensitive breasts. Taken in judicious amounts by new moms, however, I would not anticipate any problems.

If you have been keeping abreast of the news lately, you might have come across a news story that highlighted a recent study published in the New England Journal of Medicine (NEJM), which found that salt consumption wasn’t associated with an increase in systolic blood pressure in either men or women, after controlling for factors like age (1). Given that health authorities have been saying for years that salt increases the risk of hypertension, these recent findings are another wrench in works for low-salt proponents.

This is not to say that very high salt consumption is safe. There is good evidence that reducing salt intake from 9-12 g per day, in large part from eating junk food and prepackaged foods, to less than 7 g per day, does promote a significant fall in systolic blood pressure (2). The problem is getting a handle on what exactly this means, particularly when these same changes seem to have no effect on lipid levels, and the risk of dying from cardiovascular disease is at best weakly associated with high salt consumption (15% increase in risk). Once again, as I addressed in an earlier blog, we need to make sure that we don’t confuse our objectives, and remember that hypertension isn’t so much a disease as it is as diagnostic sign. Just because we can alter the findings of one diagnostic sign through various interventions, doesn’t necessarily mean that we have altered the course of the disease. It is really just another example of failing to see the forest for the trees.

Despite these rather unconvincing findings, authorities continue to suggest that we’re consuming too much salt, with the US Food as Drug Administration (FDA) suggesting that we consume less than 2.3 grams per day, and the American Heart Association (AHA) going even further by recommending that we consume no more than 1.5 grams. After all, if eating too much salt is a bad thing, dramatically reducing our consumption must therefore be a good thing – right?

Nope.

In another recent study published by the NEJM (3), researchers compared the health outcomes of patients that followed the very low sodium diet recommended by the FDA and AHA, consuming less than 3 g per day, and found that they had a higher risk of death or cardiovascular than those who consumed more than 7 grams per day:

Shocked? You shouldn’t be, because it’s not the first time we’ve seen these kind of results. A study published in the Journal of the American Medical Association (JAMA) in 2011 found much the same thing, after following 3,681 people for almost a decade that were eating either a low, moderate, or high salt diet (4). And while researchers again found that excessive salt intake was associated with an increase in systolic high blood pressure, they found that a low-sodium diet was significantly associated with higher mortality from cardiovascular causes:

According to the USDA and Health Canada, the average North American consumes only about 3.4 g of salt on a daily basis, which according to the latest research, suggests that most of us are consuming salt at the low end of the spectrum. Personally, I found these results surprising, especially considering just how much prepared and packaged food we eat, which is notorious for containing the high levels of salt which appeals to our tastebuds, activates our appetite centre, and stimulates impulse purchases. But it seems that even with what is still perceived as relatively high salt consumption, most of us are eating salt within a range that is associated with the least risk. Besides which, we’re talking about very small differences in risk, regardless of how much salt we eat. There are far bigger fish to fry, for example, when we compare the effects of eating too much salt, to the consumption of a high carbohydrate diet, which increases the risk of diabetes by 44% and the risk of CVD by 25% (5).

In Āyurveda, salt is a flavor that is an essential part of the diet, and to help maintain good health. Salt stimulates the appetite, promotes the flow of glandular secretions, and assists with the assimilation and absorption of food. It is described as viṣyañdī, meaning that it promotes tissue secretion, and sūkṣma, because salt opens the channels and promotes the easy passage of the feces, making it helpful in constipation. Salty flavor is hot, heavy and wet in quality, and helps to reduce and balance vāta, the component of the humoral theory in Āyurveda that is most closely associated with function of the nervous system. Sodium accounts for almost half the osmolarity of the extracellular fluid, playing a key role in conducting electrical impulses throughout the body. With excessive sweating or diarrhea, the loss of sodium and other electrolytes disrupts the function of the nervous system, leading to issues including nausea and vomiting, headache, mental dysfunction, fatigue, irritability, weakness, cramping, seizures, and loss of consciousness. Often people will think to drink water when they’re dehydrated, but without the addition of electrolytes such as sodium, the water will go right through them and the problem will likely get worse. Although medical organizations like to suggest oral rehydration packets loaded with sugar to restore electrolytes, research has shown that a traditional Āyurvedic salted rice soup (e.g. peya) is far more effective (6).

While I am an advocate for consuming salt, like anything, there is a down-side too. Apart from the overt effects of hypernatremia, which is almost impossible to achieve from dietary consumption, the excessive consumption of salt irritates the mucous membranes, and can lead to inflammation. In a similar fashion, excessive salt weakens digestion and promotes congestion, leading to a feeling of heaviness and lethargy. In this way, salt consumption is limited in kapha (congestive) and pitta (inflammatory) conditions in Āyurveda, but even with these contraindications, it is never eliminated entirely.

Perhaps the most important issue to consider when it comes to salt is the source. Most commercial sources of table salt are prepared from pure sodium chloride, to which various ingredients are added, including anti-caking agents (e.g. sodium aluminosilicate), and if the salt has been iodized, the addition of alkalis (e.g. sodium carbonate) and stabilizers (e.g. dextrose, sodium thiosulfate). I don’t recommend this salt for a number of reasons. Apart from the synthetic anti-caking agents and other additives, pure sodium chloride is a highly refined product, as pure NaCl doesn’t exist in nature. Typically derived from either marine sources (e.g. sea salt), or mined from prehistoric salt deposits (e.g. rock salt), natural salts contain a diversity of nutrients including calcium, magnesium and potassium, as well as a host of trace minerals. The net effect is that these natural salts moderate the direct influence of sodium in the body, and because salt craving can often be a sign of a mineral deficiency, helps to address the root cause of nutrient imbalances.

In Āyurveda, there are five basic groups of salt, called the pañca lavaṇa:

Consumed not just as a flavor or condiment, the pañca lavaṇa are viewed as therapeutic agents, used singly or in combination, found in many different formulas used both internally and topically, such as Bhāskaralavaṇa cūrṇa and Saindhavādi taila.

Saindhava lavaṇa is considered to be the best among salts, mined for thousands of years at the feet of the Himalayas in the Sindh region of the subcontinent. It is derived from the ancient Tethys Sea that at one time separated the subcontinent from Asia. Also known as pink salt, sendha namak or Himlayan salt, saindhava is a light-colored rock salt with a mild taste and sweetish-salty flavor. Saindhava is stated to alleviate all three doṣāḥ (doshas), enkindle digestion, restore electrolytes, benefit the eyes, reduce burning sensations, and enhance fertility.

Sauvarcala lavaṇa is another type of rock salt mined in the Sindh regions and elsewhere, but contains significantly higher levels of iron sulfide, providing for its blackish-red color and characteristic sulfurous odor. Also known as black salt, kala namak, sonchal or sanchal, sauvarcala is considered best for digestion and to balance vāta.

Viḍa lavaṇa is an artificially-prepared salt, made by boiling the powders of saindhava, Āmalakī, Harītakī and sarjakṣāra (sodium carbonate) in water until it is completely evaporated. Naturally rich in ammonium chloride, viḍa is black in color, and possesses an alkaline, salty flavor. It is used to correct kapha and vāta, reducing heaviness in the chest and promoting good digestion, and the proper excretion of feces and gas. Viḍa lavaṇa is generally not used for dietary purposes.

Sāmudra lavaṇa is unrefined sea salt, prepared by evaporating off the moisture from seawater. It is made all over the world, and is differentiated from refined salt by containing a high density of trace minerals, giving it a greyish, rather than pure white appearance. It has a mildly warming energy, and acts to enhance digestion, reducing vāta and the expulsion of flatus, and is only slightly aggravating to pitta and kapha when consumed in larger amounts.

Audbhida lavaṇa is a type of salt that is collected and purified from the soil by calcination, and is rich in sodium bicarbonate. It has an alkaline taste and action, and is considered to be difficult to digest, greasy in quality, cold in energy and acts to reduce vāta. It is used therapeutically, but is generally not added to food.

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About the book

Informed by the theory and practices of Ayurveda, folk medicine and scientific research, the new book Food As Medicine: The Theory and Practice of Food provides a practical and lucid model of what food is, how it impacts your health, and how to make the best choices in your diet - all depending on your individual needs. This detailed and timely book also includes meal plans and delicious recipes as well as therapeutic approaches to diet and herbs for specific conditions.

About Todd Caldecott

Todd Caldecott is a trained medical herbalist and practitioner of Ayurveda, in clinical practice since 1997. He the Executive Director of Dogwood School of Botanical Medicine, and a registered professional member of the American Herbalists Guild since 1997. He is author of the textbook Ayurveda: The Divine Science of Life and editor of a new text on Nepalese ethnobotany called Ayurveda in Nepal. Todd lives in Vancouver B.C. with his family where he practices and teaches herbal medicine and Ayurveda. Check out his website at www.toddcaldecott.com to get free information on natural health and healing.